Abstract

A modified Freer elevator was created to aid the safe placement of alloplasts in a subcutaneous dissection pocket. We believe that this innovation represents a better way to insert non-rigid facial alloplasts and grafts, and that it contributes to the reduced technique-related complications of migration, kinking and asymmetry, as well as minimizing tissue trauma and creation of unnecessary and excessive surgical explorations.

Botox® has been used in medical applications to treat muscle spasms and other conditions for nearly three decades. In 1999, it was approved in Canada for cosmetic use. It is made from botulinum toxin A, the same bacteria that cause botulism food poisoning. Dysport®, which has been marketed for several years in Europe and South America, is made from the same neurotoxin as Botox. The difference, according to several reports, is that DYsport® will act in one to two days instead of the three to five days Botox® needs to kick in.  Further, clinical trials suggest injections may be effective for up to five or six months, as opposed to about three months for Botox®.

ABSTRACT
Objective: To establish esthetic preferences with regard to the nasal appearance following rhinoplasty in order to optimize patient satisfaction.

Setting: Mt. Sinai Hospital, University of Toronto and private facial cosmetic surgery centre.

Participants: 143 subjects (53 males and 90 females); mean age range, 18-35 years), with the following cultural representation: English (25%), Asian (14%), European (22%), Indian (12%), Jewish (12%), Mixed (4%), Persian (6%), African (1%), French (4%), West Indian (1%).

Interventions: Participants completed the Rhinoplasty Outcome Preference Survey after being shown pre-and post-operative profiles of male and female patients undergoing rhinoplasty. Post-operative images consisted of computer-generated profiles of small-balanced and large-balanced noses.

Results: Overall, participants favored small-balanced rhinoplasty outcomes for females (61%) but showed nearly equal preference for small and large rhinoplasty outcomes in males (52%:A; 48%:B). This trend was consistent across gender. Cultural groups differing from this pattern included Asian males, who favored small-balanced noses in males (60%).

Conclusions: The small-balanced rhinoplasty is the most-preferred outcome for women among both male and female participants across cultural groups. Rhinoplasty preferences for men in male and female subjects were more variable and displayed cultural differences.

Abstract

Objective: To evaluate the benefit of intraoperative locally- or intramuscularly-injected Toradol in combination with local anesthetic versus local anesthetic alone on postoperative pain in patients undergoing facial plastic surgery.

Methods: Prospective randomized trial of 140 consecutive patients undergoing facelift, and/or forehead lift at a private facial cosmetic surgery practice by one surgeon.  Outcome measurement included the requirement for pain medication (none, morphine, acetaminophen with codeine or plain acetaminophen) at 1, 12 and 24 hours postoperatively.

Results: 95 patients receiving locally-injected Toradol required significantly less post-operative analgesic (P<0.05) than both the 20 patients who received intramuscularly-injected Toradol and the 25 that received local anesthetic alone at 12 and 24 hours.  Those patients receiving no Toradol required significantly more (P<0.05) analgesic 1 hour post-operatively.

Conclusion: Intraoperative locally-injected Toradol is an effective and safe means of reducing postoperative analgesic requirements.

ABSTRACT

Objective. To determine the efficacy of Gore-Tex alloplast in rhinoplasty.

Design. 17 year retrospective chart review

Setting. Teaching Hospital, Community Hospital and Private facial cosmetic surgery centre.

Intervention. 521 patients (122 male and 399 female) from 13-70 years of age, followed between 12 months to 17 years underwent Gore-Tex implantation rhinoplasty (685 implants in 158 primary procedures and 508 secondary procedures) performed by one surgeon.

Main Outcome Measures. Patient satisfaction, expressed with respect to desired cosmetic benefit and functional outcome, and physician assessment, based on aesthetic improvement, technical considerations and complications. Results were assessed according to the follow-up notes in the chart reflecting patients’ and surgeon’s comments and full pre- and post-operative photographic documentation.

Results. Gore-Tex alloplasts, 1-10 mm thick, implanted in the nasal dorsum (n=264), lateral nasal wall (n=252), supratip dorsum (n=85) and pre-maxilla (n=84) showed excellent stability and tissue tolerance.  Biological complications that required implant removal occurred in 1.90 % of patients including infection, soft tissue swelling, migration and extrusion.

Conclusions. With the exception of the nasal tip, columella, or problems in which corrections would require rigidity of the grafted or implanted material, the Gore-Tex alloplast is a safe, inexpensive, and predictable alternative to autografts. In the present series, we found Gore-Tex implants acceptable up to 10 mm thickness. It is our opinion that for both primary and secondary rhinoplasty with adequate endonasal and external soft tissue coverage, Gore-Tex should be strongly considered for major and minor corrections of the nasal wall and bridge in properly selected patients.

I’ve just introduced the latest 3D imaging system to our clinic: the Vectra 3954 with Face Sculptor, found no where else in Canada. This new technology takes 6 simultaneous photographs of your face which, when overlaid, produces a living three dimensional recreation.

Your 3D image can then be modified to give you a realistic idea of how you might look with a different nose, chin, or even lips! This really takes the guess work out of envisioning your post-procedure outcome and sets a new standard for patient surgical planning. I’m very pleased to be able to offer this exciting new technology to my patients and can’t wait to help you visualize the outcome of your dreams.

Second, find out where your cosmetic surgeon performs surgery: a hospital or private surgery centre. Safety should be the primary concern of either location with properly trained and experienced staff. Often time, if you choose a private surgery centre, the date of procedure is tailored to your schedule and much more flexibility exists. However, make sure that you inquire about the type of anesthetic used and whether or not an anesthesiologist will be present during your procedure. Finally, choosing a cosmetic surgeon is based upon trust. Make sure that your surgeon takes the time to understand your needs and desires. It’s important that your surgeon establishes an action plan that you both agree to. As well, make sure that all the risks and benefits of your procedure have been properly explained to your satisfaction. This will ensure the best chance of matching your expectations with the final outcome.